NPIMap

Organization Active NPI

X Awaiting Inactivation3

  • Military Hospital
  • Fort Rucker, AL
National Provider Identifier
1174774863
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military HospitalTaxonomy code 286500000X
License
B1614161 Issued in AL
Legal business name
X AWAITING INACTIVATION3
Practice address
301Dustoff Ave
Lyster Army Health Clinic
Fort Rucker, AL 36362-5333
Phone
(334) 255-7755
Fax
(334) 255-7368
NPI assigned
Oct 1, 2008
Organization subpart
Yes
Parent organization
X AWAITING INACTIVATION3As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Michael Condon
Title
Ubo
Phone
(240) 401-3643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military Hospital 286500000X B1614161 AL Primary

Addresses

Primary practice location

301Dustoff Ave
Lyster Army Health Clinic
Fort Rucker, AL 36362-5333

Mailing address

301Dustoff Ave
Lyster Army Health Clinic
Fort Rucker, AL 36362-5333
Phone (334) 255-7755

National Provider Directory

National Provider Directory
Tax ID family
316TH Medgrp-Malcolm Grow3 organizations share this tax ID, including this one
Part of
Brooke Army Medical Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1174774863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301DUSTOFF AVE",
            "address_2": "LYSTER ARMY HEALTH CLINIC",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363625333",
            "telephone_number": "334-255-7755",
            "fax_number": "334-255-7368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301DUSTOFF AVE",
            "address_2": "LYSTER ARMY HEALTH CLINIC",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363625333",
            "telephone_number": "334-255-7755",
            "fax_number": "334-255-7368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "X AWAITING INACTIVATION3",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "X AWAITING INACTIVATION3",
        "enumeration_date": "2008-10-01",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "UBO",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "taxonomies": [
        {
            "code": "286500000X",
            "taxonomy_group": "",
            "desc": "Military Hospital",
            "state": "AL",
            "license": "B1614161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Rucker, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.